Ilizarov Technique in the Correction of Equinus Deformity / 대한정형외과학회잡지

ABSTRACT

The introduction and adaptation of the methods of Ilizarov could be achieved correction of equines in patients with major problems such as posttraumatic equines associated with severe soft tissue injury that would not allow the use of conventional surgical methods. In order to evaluate the factors causing complications and affecting the results, we reviewed 12 cases in which the equines deformity of feet were corrected by the Ilizarov method from May 1991 to August 1995. Mean follow up periods were 18 months. The average age of patients was 28 years(ranged from 8 to 56 years). The causes of equines were posttraumatic 9, Charcot-Marie-Tooth disease 1, residual poliomyelitis 1, and deformity of unknown origin 1, and four cases were associated varus deformity. Correction periods was from 4 to 14 weeks(average 7 weeks), fixation period from 1 to 16 weeks(average 6.2 weeks). The additional immobilization with cast or brace was from 4 to 44 weeks, and then rehabilitation was done. Initial equines deformity was averaged 39.5 degrees (range 20-70 degrees). We obtained average 33 degrees of deformity correction which means the average 6.5 degrees of equines still was remained at the last follow up. Range of motion was improved from preoperative 11 to postoperative 20 degrees. One posttraumatic patient with calcaneal varus and loss of calf muscles, and one residual poliomyelitis patient recurred during follow up. We performed the triple arthrodesis and Achilles lengthening in one case of Charcot-Marie-Tooth disease and one case of equines deformity of unknown origin. Gait pattern and pain was improved in all but 2 cases with mild pain in walking. Complications during or after treatment were recurrence(2), anterior subluxation of talus(5), claw toe(10), partical rupture of Achilles tendon(1), valuges or varus deformity (4), posterior tibial nerve injury(1), rockerbottom deformity(2) and pin tract infection(5). The case of recurrence or second operation coourred in 4 of 12 cases(33%). To prevent the recurrence of equines deformity, we recommend that long period of maintainance, adequate cast immobilization or brace more than 3 months, and continuous rehabilitation. The key to prevent subluxation of talus was a precise hinge placement at the center of talar dome and, if subluxation of talus was occurred, it should be corrected by anterior or posterior translation using olive pin. It should be corrected by flexor tendon lengthening during correction period or after removal of Ilizarov, if claw toew deformity occurred.